Reasons to believe in vaporization: a review of the benefits of photo-selective and transurethral vaporization
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TOPIC PAPER
Reasons to believe in vaporization: a review of the benefits of photo‑selective and transurethral vaporization Russell N. Schwartz1 · Felix Couture2 · Iman Sadri3 · Adel Arezki3 · David‑Dan Nguyen3 · Ahmed S. Zakaria4 · Kyle Law3 · Dean Elterman5 · Malte Rieken6,7 · Hannes Cash8 · Kevin C. Zorn4 Received: 21 April 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In the current review, we will discuss the state of the literature of vaporization of the prostate for the treatment of benign prostatic enlargement (BPE). We discuss two methods of vaporization of the prostate: Transurethral Vaporization of the Prostate (TUVP) and Greenlight Photo-selective Vaporization of the Prostate (PVP). Methods A comprehensive review of the literature was performed on TUVP and PVP. The literature on transurethral resection of the prostate (TURP) was also extensively reviewed as a comparative surgical method. Results The evidence shows that TUVP appears to be the safer choice, as compared to TURP due to less intra- and perioperative complications. PVP was associated with less bleeding complications than TURP with outpatient discharge. Importantly, PVP was not associated with serious bleeding events requiring blood transfusions or medical treatment in patients under anticoagulation or antiplatelet therapies. PVP was also shown to be a cost-effective option compared to TURP. Conclusion Prostate vaporization for the treatment of BPE appears to be an efficient and safer alternative to TURP. Vaporization techniques, particularly Greenlight PVP, should be offered to most men, especially those under anticoagulation therapy, as well as patients at risk of bleeding complications. Keywords BPH · TUVP · PVP · Greenlight · Vaporization · LUTS
Introduction The aging of the population has led to an increasing number of men affected by benign prostatic enlargement (BPE). Studies have found that lower urinary tract symptoms * Kevin C. Zorn [email protected] 1
Université de Montréal, Faculté de Médecine, Montreal, Canada
2
Département d’Urologie, Centre Hospitalier de l’Université de Sherbrooke, Montreal, Canada
3
McGill University, Faculty of Medicine, Montreal, Canada
4
Département d’Urologie, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
5
Division of Urology, University of Toronto, Toronto, Canada
6
alta uro AG, Basel, Switzerland
7
University of Basel, Basel, Switzerland
8
Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
(LUTS) associated with BPE increase linearly with age, with up to 50% experiencing LUTS by age 50 and 80% by age 80 [1]. While medical treatment of LUTS remains the first-line therapy, according to the American Urological Association (AUA) and the European Association of Urology (EAU) guidelines, surgical therapy is indicated for patients who have renal insufficiency secondary to BPE, refractory urinary retention, recurrent urinary tract infections (UTIs),
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